"Breaking the bureaucracy": drug registration and neocolonial relations in Egypt

According to the Egyptian Ministry of Health, the per capita use of prescription drugs in Egypt is amongst the highest in the world. Multinational pharmaceutical companies license their proprietary products for manufacture and sale in Egypt through their Egyptian subsidiaries. A Ministry of Health Committee reviews and approves for sale all drugs marketed in the country. Aside from being an extremely lucrative market itself, approval of a drug for sale and manufacture in Egypt also opens to the pharmaceutical companies other markets in the Arab world. The Egyptian drug approval process is thus both important for assuring the health of Egyptian nationals and a high-stakes activity for the pharmaceutical companies. This paper examines the social relations and interactions of multinational pharmaceutical representatives in Egypt with Egyptian researchers in relation to the Ministry of Health's drug approval process. From time-to-time events focus attention on the huge financial rewards reaped by multinational pharmaceutical companies from their activities in lesser developed countries. This attention not infrequently has revealed the "drugging of the Third World" as a result of actions by expatriate multinational pharmaceutical officials. Indigenous review procedures such as those established by the Egyptian Ministry of Health might guard against such external exploitation. This paper shows how in place of external exploitation, indigenous pharmaceutical company officials have manipulated local patterns of social interaction to construct a system of reciprocal obligations which may frustrate intended safeguards, and by reconstructing colonial institutional structures, creates a pattern of neocolonialism in Egypt.